Introduction: Patients with acromegaly are often left with long-term sequelae, among which arthropathy is the most common. Studies have shown impaired quality of life (QoL) in patients with acromegaly, even after long-term remission. Arthropathy is a negative predictive factor of QoL, due to its impact on physical symptoms and functioning.
Patients/Methods: To characterise further the extent of the acromegalic arthopathy, we conducted an observation study on 62 patients with acromegaly. Participants were interviewed individually for the presence, distribution and severity of joint-related symptoms. Additionally, participants medical records were reviewed and acromegaly-related data were collected.
Results: 29 male and 33 female patients with acromegaly (mean age 55±13 yrs) were recruited. 83.8% had pituitary surgery, 41.9% had radiotherapy and 85.5% received medical treatment. Mean duration of active disease and disease remission were 14.3±10.0 yrs and 5.5±7.6 yrs respectively. Based on biochemical criteria, 46.8% of patients had active acromegaly during the study, whereas 53.2% were in remission, which was achieved with or without long-term medical treatment.
88.7% of patients reported arthralgia (mean severity score 3.8±2.8 on a 010 scale). The most commonly affected joint site was the knee (71%), followed by the small joints of the wrist/hand (51.6%) and the lower spine (45.2%). 79% of patients reported pain in >1 sites. Joint symptoms were bilateral in 83.8% of cases. 56.5% of patients required analgesia for arthralgia; 51.4% of them on a regular basis. 24.2% of patients had previously undergone joint surgery due to arthropathy (mean age of 51.2±13.1 yrs). In 60% of those cases, patients required surgery in >1 joints.
Conclusions: Acromegalic arthropathy is a symmetrical polyarthropathy, affecting both the axial and appendicular skeleton and remains a major cause of morbidity in acromegaly. It may progress to a debilitating pathology, with patients requiring joint replacement at a relatively young age. Joint-related symptoms should be assessed regularly during clinic appointments. Future research should focus on developing strategies for prevention of the acromegalic arthropathy.